ICHRA vs Traditional Health Insurance: A Comprehensive Comparison

Jeremy Wolf |


  • With the health benefits landscape constantly evolving, understanding ICHRAs, HRAs, FSAs and HSAs can be difficult. Each provides access to tax-free health benefits, but they serve different purposes.

  • ICHRAs empower employees to choose their own healthcare plans with pre-tax dollars, often resulting in significant savings.

  • While employees sometimes struggle to navigate insurance options to pair with their ICHRAs, services like Thatch help employees find and select healthcare that meets their needs.

In this article, we'll compare ICHRA against traditional health benefits like HRA, FSA, and HSA. This is important because the healthcare benefits market constantly evolves, offering numerous options for employers and employees. Some of the most popular options include ICHRA, HRA, FSA, and HSA — sometimes called the "healthcare payment rails." We'll cover the basics of each, helping you make an informed decision.

Understanding ICHRA - Exploring the Basics

ICHRA has gained popularity in recent years due to changing dynamics within the healthcare industry. With rising costs of group healthcare plans and an increasing demand for personalized options, ICHRA provides an answer that benefits employers and employees alike. 

What is an ICHRA exactly?

The term “ICHRA” stands for Individual Coverage Health Reimbursement Arrangement. It’s a health benefits arrangement in which employers give workers an allowance that they can use to purchase their own insurance coverage instead of getting it through a group plan underwritten by their employer. Since its ‎‎introduction in 2020, ICHRA has enabled flexible, employee-centric health benefits.

ICHRA usage grew 350% within two years of its introduction, according to an inaugural HRA Report from the HRA Council, a nonprofit, nonpartisan advocacy organization comprised of HRA administrators, carriers, enrollment firms, and practitioners.

ICHRA promotes transparency in healthcare spending, as employees know the exact amount allocated for health insurance. This transparency can lead to better financial planning and utilization of healthcare resources, benefiting employees and employers in the long run.

Imagine an employee who has particular medical requirements, like a chronic illness necessitating specialized treatment; under ICHRA, they can select a policy, based on their allowance, that covers their specific doctors, treatments, and drugs, ensuring they get the necessary care.

Companies can budget better and more effectively because they know exactly how much each employee spends on medical expenses every year. Meanwhile, employees can enjoy a more flexible and personalized health benefits offer.

Pros and Cons of ICHRA Health Insurance for Employees

Now that we know what ICHRA is, let’s discuss its pros and cons for employees.

Benefits of ICHRA for Employees

ICHRAs benefit workers in a number of ways:

  1. Personalized plan selection: One of the most significant advantages of ICHRA is the empowerment it gives employees when choosing their health insurance plans. Unlike traditional group plans where options are pre-selected by employers and limited, ICHRA allows employees to select from a wide range of plans on the open market, catering to their specific healthcare needs and preferences.

  2. Pre-tax benefits: Reimbursements by employers to employees under the ICHRA are pre-tax, in that they do not get reported as taxable income to the ICHRA participant.

  3. Flexibility and control: Employees have the flexibility to choose not only the insurance provider but also the level of coverage they prefer. Whether they need basic coverage or a more comprehensive plan, employees can decide based on their health requirements and budget.

  4. Portability: In traditional group insurance policies, coverage typically ends when an employee leaves his or her job. With ICHRA, the employee owns their healthcare and can continue paying premiums even after they leave their job or the ICHRA terminates. This enables ICHRA participants to enjoy continuous coverage and fewer healthcare interruptions between jobs.

  5. Lower premiums: ICHRA encourages competition among insurers because employees can choose where to spend their allowances. In other words, ICHRA insurance options may be better and available at lower premiums.

The Downside of ICHRA for Employees

  1. Complexity in choice: While having a variety of choices is beneficial, it can also be overwhelming for some employees. Navigating through over 60,000 health plans can be daunting, requiring employees to invest time and effort in understanding different plans to make informed decisions.

  2. Potential for higher out-of-pocket costs: Depending on the budget, some employees might find that the plans available within their budget have higher deductibles or out-of-pocket costs. This could lead to employees paying more for their healthcare, especially if they opt for plans that exceed their budget.

  3. Administrative burden: In some cases, the initial setup and selection process can be complex. Employees must understand how to apply their allowances effectively and may need to navigate the health insurance marketplace for the first time, which can be a significant shift from the simplicity of enrolling in a group plan.

Do I have to offer ICHRA to all employees?

Employers can decide which employees are eligible for ICHRA by selecting specific classes of employees to offer it to. At the same time, Employees can choose whether to opt in or out of the ICHRA. Businesses need not overlook using ICHRAs as a strategic decision to attract top talents while retaining current ones. 

Traditional Health Reimbursement Arrangements – What is the difference between HRA and ICHRA?

Health Reimbursement Arrangements (HRAs) and Individual Coverage Health Reimbursement Arrangements (ICHRAs) are both employer-funded health benefits designed to reimburse employees for medical expenses. HRAs are designed to reimburse employees for non-premium qualified medical expenses, and they're more commonly used where an employer already offers group health insurance. ICHRAs are designed to reimburse both individual health insurance premiums and other qualified medical expenses. If an employer offers an ICHRA to a class of employees, those employees aren't eligible for group coverage.

Consider a small business owner with a diverse workforce and a variety of healthcare needs. Under a traditional HRA, the owner might offer a group health plan that doesn't fit everyone's needs, leading to dissatisfaction or underutilized benefits. With an ICHRA, the same business owner could allocate a set monthly allowance for employees to spend on the individual health insurance market. This way, a young, healthy employee might choose a less expensive, high-deductible plan, while another employee with a family might select a more comprehensive plan that better covers their needs. This flexibility enhances employee satisfaction by allowing them to choose coverage that best fits their personal situation, illustrating the core difference between HRAs and ICHRAs in terms of choice and customization.

Traditional HRAs often cover various medical expenses such as copayments, deductibles, and coinsurance, providing greater financial assistance to employees for their healthcare costs. For instance, if an employee needs to undergo surgery while enrolled in a traditional HRA plan, funds from this account could help by paying the deductible and other out-of-pocket expenses incurred during the operation, which would relieve them of a significant financial burden.

Eligibility Criteria: ICHRA Vs Traditional HRA

One major difference between ICHRA and traditional HRA is the eligibility criteria. ICHRA is available to employees regardless of company size, while traditional HRAs often require being tied to specific group insurance plans or have stricter requirements based on various factors such as the number of years worked. This also means that employers can adopt ICHRA for both part-time and full-time workers.

Tax Implications: ICHRA Vs Traditional HRA

For tax purposes, both ICHRA and traditional HRA enable employers to deduct contributions against their taxable income. Similarly, employees can get tax-free reimbursements on qualified medical expenses paid using funds from either an ICHRA or a conventional HSA. In the case of ICHRA, this includes reimbursements for individual health premiums.

Flexible Spending Account (FSA) – What is the difference between FSA and ICHRA?

Flexible Spending Accounts (FSAs) and ICHRAs are both employer-sponsored programs designed to assist employees with healthcare expenses, but they operate under different mechanisms and offer distinct benefits.

An FSA is a type of savings account that allows employees to contribute a portion of their earnings pre-tax to pay for qualified medical expenses. This setup can lead to significant tax savings, but it comes with a "use it or lose it" policy, meaning employees must spend the funds within the plan year or risk forfeiting the remaining balance. Some plans allow a small carryover or grace period. FSAs are employer-established, and while they offer immediate access to the full annual contribution amount, they are limited by annual contribution caps set by the IRS.

FSAs come in handy when you expect high medical costs because whatever amount you put in there won’t attract any tax, saving some cash on taxes while still putting aside money for your health care needs.

Think about an employee who knows they will have to buy prescription drugs all through the year. Pre-tax dollars can be used to pay for these prescriptions by contributing to an FSA, thus reducing overall healthcare costs.

On the other hand, ICHRAs are not savings accounts but rather employer-funded health reimbursement arrangements. Employers provide a set monthly allowance to employees, who can then purchase individual health insurance on the open market and get reimbursed for premiums and other qualified medical expenses up to the allowance amount. ICHRAs offer flexibility in plan choice and the potential for tax-free reimbursements, making them an attractive option for employers looking to provide health benefits without the constraints of a traditional group health plan. Depending on the ICHRA, funds may accumulate during the plan year. Furthermore, ICHRAs can accommodate a wide range of budgets and business sizes, offering a customizable approach to health benefits.

In summary, while FSAs focus on setting aside pre-tax dollars in an account from employee earnings to cover healthcare costs within a plan year, ICHRAs allow employers to reimburse employees for insurance premiums and medical expenses, providing a flexible and tax-efficient solution for both parties.

ICHRA vs FSA Contribution Limits

The IRS has set a maximum amount that an individual may contribute each year to their flexible spending account (FSA), in terms of contribution limits. In contrast, no predetermined upper limit exists for annual contributions towards an ICHRA.

By not having any contribution limits, ICHRA enables employers with the means and desire to provide more generous packages that cover all their workers’ health needs.

Health Savings Account (HSA) – What is the difference between HSA and ICHRA?

An HSA (Health Savings Account) allows individuals to set aside money on a pre-tax basis to pay for qualified medical expenses. To be eligible to contribute to an HSA, an individual must be enrolled in a high-deductible health plan (HDHP). HSAs are notable for their triple tax advantage: contributions are tax-deductible, the account's growth is tax-free, and withdrawals for qualified medical expenses are not taxed. The funds in an HSA roll over from year to year, and the account is owned by the individual, meaning it stays with them regardless of employment changes. Importantly, individuals cannot spend HSAs on health insurance premiums.

HSAs are available only to individuals covered by HDHPs and work well for those who want more control over how their healthcare dollars are spent.

For instance, let's consider an employee who rarely falls sick but has insurance coverage in case of emergencies. An HSA enables saving for future medical bills.

In contrast, an ICHRA is an employer-funded health benefit used to reimburse employees for individual health insurance premiums and other qualified medical expenses, tax-free. Unlike HSAs, ICHRAs do not involve employee contributions to an account, and they're entirely funded by the employer. Employers set a fixed allowance for their employees, who can then purchase individual health insurance on the open market. Any reimbursement from an ICHRA for health insurance premiums or medical expenses does not count as taxable income to the employee. ICHRAs offer flexibility and personalization, as they allow employees to choose the health insurance plan that best fits their needs, rather than being limited to the options provided by an employer-sponsored group health plan.

Given the eligibility requirements and spending limitations for HSAs, ICHRAs are a better option for employers looking to provide healthcare benefits to a wider range of employees.

Contribution Limits: ICHRA Vs HSA

Similarly to HRA, The IRS sets maximum annual contribution limits for HSAs. Conversely, there are no predetermined maximum contribution limits for ICHRA.

This lack of contribution limits allows employers to offer more comprehensive healthcare benefits through ICHRA that cater to the different needs of their workforce.

Tax Aspects: ICHRA Vs HSA

Both ICHRA and HSA boast tax advantages for both employers and employees.

Employers can deduct contributions made towards an ICHRA from their taxable income; the same contributions are not taxed as employee income. Contributions given towards an HSA are generally deductible from taxable income by both employers and employees, grow free of tax, and may be withdrawn without taxation when used for qualifying medical expenses.

Understanding these tax implications intricately is important when deciding what works best based on your financial goals and needs.

Conclusion: Choosing the Right Health Insurance Option

It is important for businesses to choose the right healthcare benefit option since it has a significant impact on financial planning and employee satisfaction. As discussed here, there are different types of healthcare benefits available, such as ICHRA, HRAs, FSAs, and HSAs, each with its own benefits and limitations. Employers should consider their company size, workforce demographics, and financial goals (among other dimensions) to determine the most appropriate option.

By understanding the differences and tax implications of each arrangement, businesses can provide valuable healthcare benefits that support their employees' well-being and align with organizational goals. Therefore, selecting whether to provide an ICHRA, HRA, FSA, or HSA should be based on carefully evaluating these factors to ensure adequate coverage for the employer and its employees.

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